Physician says 'Medicare for all'

On Sept. 16, the Census Bureau reported that in 2014 the number of uninsured Americans dropped by another 9 million. The estimates are that as many as 16 million more people now have health insurance since the Affordable Care Act was passed.

In addition to this, everyone who has health care now benefits from: protection for pre-existing conditions, no lifetime cap, and basic preventive care such as contraception and colonoscopy. This is huge. It marks a change in social standards.

But the ACA was implemented as the regulation of a market-based system. So cost-shifting to the consumer is now taking place, as would be expected. This means higher deductibles and co-pays and cost-sharing, leaving a large number still under-insured even if they have coverage, and susceptible to financial stress, or illness due to postponing care.

As experience in other countries has demonstrated, affordable universal care is possible only through tighter market regulation approaching a single-payer model (such as Medicare or Canada's system) or a single employer, such as the VAMC or the British system.

In 2014, the Commonwealth Fund reported that the British system, in comparison with the systems of 10 other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the U.S.), was rated the best in terms of efficiency, effective care, safe care, coordinated care, patient-centered care and cost-related problems, and second for equity.

It would seem wise to repeal Obamacare only after we are able to replace it with a similarly effective program: Medicare for all.